Background on Health Care

OBAMACARE

‘ObamaCare’ refers to the Patient Protection and Affordable Care Act (PPACA) of 2010, which reformed healthcare insurance with the goal of near-universal coverage.

Critics refer to ObamaCare as socialized medicine -- which could mean the government runs the healthcare system, as in the United Kingdom, but more accurately in the United States means that the federal government mandates individual health coverage.

Individual Mandate: The crux of the opposition to ObamaCare is whether the federal government can mandate that individuals purchase health insurance -- that was tested in a Supreme Court case in 2012.

The Supreme Court decided the case “National Federation of Independent Business v. Sebelius” on June 28, 2012, on the constitutionality of ObamaCare’s individual mandate. Justices Roberts and Kennedy were very skeptical that the mandate was justified under the “commerce clause.” But the government’s lawyer made a strong case for the government’s taxing power—that argument eventually won the day—because the mandate would be administered by the Internal Revenue Service, paid on your Form 1040 on April 15th. The president had argued that the mandate was not a tax; the court decided it was.

‘HillaryCare’ refers to the Health Security Act of 1993, for which Hillary Clinton chaired the task force devising the plan. The plan was attacked, and ultimately failed, for several reasons:

The Health Care Task Force met behind closed doors rather than in public hearings;

The plan was considered too “top-down,” with too much federal bureaucratic control instead of state & local control and personal choice;

The plan focused on regulating HMOs and hence on federal regulation of the private healthcare market.

ObamaCare (and RomneyCare) borrowed many features from HillaryCare but attempted to correct those fatal shortcomings.

‘RomneyCare’ refers to the Massachusetts state version of mandated healthcare initiated under Gov. Mitt Romney -- its principal difference being a STATE mandate instead of a FEDERAL mandate.

‘Single Payer’ refers to replacing private insurance companies with federal or state payments to hospitals and doctors. The 'public option' in ObamaCare would have been a voluntary opt-in to single-payer. 'Medicare-for-All' is a form of single-payer, by expanding the Medicare system to cover all Americans.

Opponents of ObamaCare suggest replacing it with the following list of reforms: cross-state purchasing; tort reform; Health Savings Accounts; small business pooling; and transparency for better patient choice.

Tort Reform refers to changing the rules about civil litigation, typically to cap damage awards. In a political context, it usually applies to medical malpractice lawsuits, but in a legal context, it also applies to personal injury and product liability lawsuits. The term "tort" means "at fault;" when a doctor is found at fault, a jury can currently award unlimited damages. Awards in the millions of dollars put upward pressure on malpractice insurance rates; hence many conservatives favor tort reform as a means to reduce healthcare costs. Proposed solutions include capping lawsuit compensation or restricting "frivolous lawsuits." Trial lawyers--the recipients of legal fees from tort awards--heavily favor Democratic candidates, so Republicans would like to limit their legal fees.

Mental Health ObamaCare suggested some mental health coverage but the details are left to each state. Mental health is one of ObamaCare’s“10 Essential Health Benefits.” This is an example of healthcare issues that were not fully worked out under ObamaCare, and will be left to the 2016 election to decide.

HMOs & MANAGED CARE

Prior to ObamaCare, comprehensive national health care reform had died in Congress in 1994 (after a report by a commission run by Hillary Clinton, hence the moniker "HillaryCare").

16% of Americans (42 million people) have no health insurance (and hence must pay for health services in full, or receive hospital charity).

14% of Americans receive some form of public health care or health insurance (70% have private health insurance).

20% of Americans are members of Health Maintenance Organizations (HMOs).

ObamaCare ensures that mental health services are available as part of health insurance services, but leaves implementation to the states, and leaves all aspects of mental health coverage as optional. An estimated 25% of American adults suffer from a diagnosable mental illness, but stigma and funding cuts often prevent diagnosis and care. The current focus in on youth mental health, in the wake of several school shootings, and veteran mental health, in the context of PTSD in those returning from war zones.

PATIENT’S BILL OF RIGHTS

Congress and the Presidential candidates are debating a ‘Patient’s Bill of Rights’ which would establish rules of dealing with HMO managed care. The buzzwords in this debate are:

External Appeal: Patients cannot currently appeal an HMO’s decision to deny coverage, even if the HMO doctor agrees with the patient. The ‘Bill of Rights’ would establish some form of expert appeal board external to the HMO.

Medical Necessity: At issue is whether the doctor or the HMO management determines what is necessary. Determination of ‘necessity’ may become subject to expert review as well, or it may become measured against established standards of ‘generally accepted practices.’

Legal Liability: Patients would be granted the right to sue HMOs for medical costs and damages, which is not a right under current law. Generally, liberals supoprt the right to sue HMOs while conservatives do not. This is the primary distinction between Republican and Democrat versions of Patient Bill of Rights proposals.

Scope of Coverage: Some states regulate HMOs in ways similar to those described here; a ‘Bill of Rights’ could apply to them, to all HMOs, or to all patients.

Prevention: Advocating prevention implies support for removing government from health care, or opposition to more federal health care funding or national insurance.

Consumer Choice: Advocating consumer choice or reduction in healthcare bureaucracy implies support for removing government from health care, or opposition to national insurance.

MEDICAID / MEDICARE

Medicaid is the federal health insurance program for people whose income is insufficient to pay for health insurance privately, including their children. Medicaid is "means-tested."

Medicare is the federal long-term health insurance program. It provides insurance for elderly non-working people, as well as younger people with disabilities who are unable to work.

CHIP: (originally called SCHIP, the State Children's Health Insurance Program): CHIP is the federally-funded and state-run program for health insurance for children whose families earn over the Medicaid means-testing limits.

Means Testing: The limit for qualifying for Medicaid is 130% of the poverty line. The poverty line is $23,050 for a family of four in 2012 (it goes up each year, and goes down for fewer kids).

Medicaid Expansion:
Under ObamaCare, the limit for qualifying for Medicaid is raised from 130% to 133% of the poverty line, with subsidies for families earning up to 150% of the poverty line.
As of September 2014, 27 states have adopted the Medicaid expansion.
For states that do expand Medicaid, the federal government pays for 100% of the expansion through 2016, and the subsidy tapers to 90% by 2020.
Several opposing states argue that their 10% responsibility of funding the expansion will be too much for their states' budgets.
As of 2016, sixteen states rejected Medicaid expansion; of those, 15 have Republican governors and only one (Missouri) has a Democratic governor.

Medicare Part D: The most recent major change to Medicare was to include prescription drug coverage, which is called "Part D". The four parts of Medicare are:

Medicaid Expansion: The Patient Protection and Affordable Care Act (ObamaCare) expands Medicaid eligibility beginning Jan. 1, 2014.
Under pre-ObamaCare rules, eligibility varied from 100% to 130% of the poverty line; under ObamaCare, eligibility is increased to 133% (and 138% for most cases).
The expansion of Medicaid and CHIP make 6.3 million additional Americans eligible for coverage.
States individually decide whether to accept additional federal funds for Medicaid expansion; many Republican-run states which oppose ObamaCare have turned down the funds.
Federal funding fully covers the Medicaid expansion initially, but scales down to 90% over a decade.

Medicare and Medicaid background is covered from a financial/budgetary perspective in the Social Security section (with many excerpts cross-referenced here).

EUTHANASIA

The Supreme Court ruled unanimously in June 1997 that there is no constitutional right to euthanasia, but that states can allow euthanasia without federal intervention.